Tackling the Health Consequences of Homelessness, One Patient at a Time

Each year during National Health Center Week (NHCW) we celebrate the contributions of community health centers nationally in providing affordable, accessible, and effective high- quality care services. Since the first health centers were established over 50 years ago, addressing the social determinants of health – those social, economic and physical conditions which determine health outcomes – has been intrinsic to the community health center model. While all health centers address social determinants as part of their mission, some health centers also receive specific funding to focus on certain special populations, including homeless persons. During NHCW a day is set aside to recognize each of the special populations served by CHCs, and this year (2015) Health Care for the Homeless Day is observed Wednesday, August 12.

Homelessness continues to be a widespread problem throughout the country. An estimated 1.13 million homeless people were served by community health centers in 2013, the most recent year for which data are available at this time. In New York City, the number of homeless people has soared to record-breaking heights, driven by the growing gap between stagnating or falling incomes and rapidly rising housing costs, along with reductions to programs providing permanent housing subsidies or support. A recent report by the Coalition for the Homeless, “State of Homelessness 2015,” documents that the majority of the homeless in the shelter system in NYC are families. The majority of homeless shelter residents are families (roughly 79%) and 42% are children. As in other areas, homelessness in New York City disproportionally impacts people of color and according to Coalition’s report, in NYC one out of 31 African American families (3.2%) and 1 out of 57 Latino families (1.8%) utilized the NYC shelter system at least one night compared with 1 in 615 white families (0.2%). In this landscape, health centers for the homeless provide more than just a medical visit, and serve as an essential lifeline for their patients.

Care for Homeless, a community health center serving homeless New Yorkers, is one of several NYC CHCs at the forefront of offering healthcare and social services. The CHC has evolved and grown in order to best serve the unique needs of homeless people, many living in shelters or on the street, whose lack of economic resources, transportation and proper nutrition make them especially vulnerable.

The health center’s CEO, Bobby Watts, explains the Care for the Homeless model, which meets patients where they are. Instead of having a few large centralized health care facilities, Care for the Homeless is made up of 33 small drop-in centers across the city housed within other facilities such as soup kitchens, food pantries and shelters. A street outreach team and mobile health unit travel to various public parks and other locations in the city where homeless people find shelter. By providing care in these nontraditional settings, where clients are already getting services and don’t feel stigmatized for being homeless, CFH removes key barriers to care. Services are available on an open access basis which has proven more effective than traditional scheduled appointments.

Many patients have chronic medical and mental health conditions such as hypertension, diabetes, asthma and other conditions and a big challenge is educating patients on how to manage their illness and giving them access to life-sustaining medications as well as specialty care. Podiatry, dentistry mental health and substance abuse treatment services are offered across the various sites along with primary care. Care for the Homeless also operates Susan’s Place, a transitional residence dedicated to serving medically frail and mentally ill homeless women. Located in the Bronx, Susan’s place offers on-site medical and dental care and healthy meals along with social services. Yet experiencing homelessness exacerbates existing health problems and causes new ones – such as acute infections, communicable diseases, injuries, and pneumonia – which are especially difficult to treat among those who have no stable residence, and there is still a need for more specialty services and specialty providers who are equipped to treat homeless patients.

Recognizing the unique needs of those who experience homelessness, in addition to providing direct care, Care for the Homeless advocates for policies to create and protect safe, affordable housing as well as social and economic supports for homeless New Yorkers. Jeff Foreman, the health center’s Policy Director, explained that the health center is committed not only to delivering high-quality and client-centered healthcare but also to advocating for policies to ameliorate, prevent and end homelessness based on the tenet that society has a moral responsibility to provide shelter and health care for everyone. He noted that apart from this moral imperative, there is a strong financial argument for providing shelter to homeless people: the cost of having large numbers of people living in the streets and housing them in shelters is far greater than that of permanent housing. Repeated incarcerations, along with hospitalizations and emergency room visits among homeless individuals, puts a drain on public resources, while stable housing improves health and lowers costs. Having access to permanent stable housing is among the most basic social determinants of health.

Care for the Homeless is committed to the fight to end homelessness through direct service to homeless adults and families and is a strong advocate for policies that will create permanent affordable housing and prevent future homelessness. They work to provide the best possible care to a population that faces significant social and health inequalities. Building on Dr. Jack Geiger’s revolutionary model for care, Care for the Homeless recognizes that the most important prescription they can write for their patients is for healthy affordable housing. Meanwhile, they continue to offer respectful, dignified and high-quality medical and health services to those already sick, and those most vulnerable. During National Health Center Week we recognize their extraordinary devotion, an example of the enduring commitment of our city and nation’s health centers to caring for those most in need.